Healthcare Provider Details

I. General information

NPI: 1104256171
Provider Name (Legal Business Name): MD SAIF AL HAQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W FAIRBANKS AVE
WINTER PARK FL
32789-4511
US

IV. Provider business mailing address

2325 W FAIRBANKS AVE
WINTER PARK FL
32789-4511
US

V. Phone/Fax

Practice location:
  • Phone: 407-539-0311
  • Fax:
Mailing address:
  • Phone: 407-701-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME127631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: